Eating Disorders, Suicidal Thoughts, and Self-Harm

With International Survivors of Suicide Loss Day on the horizon, it’s important to recognize that suicide attempts, suicidal thoughts, and self-harm can be significant challenges for people dealing with eating disorders. For instance, people with an anorexia diagnosis have been found to be at a greater risk of suicide than people with almost any other mental health diagnosis. Research also indicates that rates of suicide attempts and suicidal thoughts (in clinical terms, suicidal ideation) tend to be higher for people with bulimia diagnoses. Additionally, studies show that non-suicidal self-harm behaviors—such as cutting, burning, or compulsive behaviors like skin picking—are also associated with eating disorder diagnoses, and in turn, such behaviors may be associated with an increased risk of suicide.

Given these well-documented trends, it’s essential that eating disorder treatment be carefully tailored to assess for and treat suicidal thoughts and self-harm. These behaviors are common across outpatient eating disorder treatment settings, but treatment approaches are far from standardized. However, Columbus Park uses a treatment model that’s been shown to most effectively address suicidal thoughts and self-harm in people with eating disorders: Dialectical Behavior Therapy, or DBT.

How DBT Can Help

Initially developed by Marsha Linehan to treat individuals with borderline personality disorder, DBT has since been shown to be effective in treating a range of mental health disorders. In particular, research has shown that DBT is the gold standard intervention for reducing the occurrence of both suicide attempts and non-suicidal self-injury.

DBT relies on a mindfulness-based therapeutic approach, and it traditionally includes four core components: individual therapy, group skills training groups, between session telephone coaching (by the therapist), and a team-based approach to treatment. Several studies have illuminated how this multilayered, skills-focused approach to treatment provides a supportive and empowering structure that can help reduce the occurrence of suicidal thoughts and self-harming behavior.

DBT in Eating Disorder Treatment

Although DBT was not originally designed for treating people with eating disorders, it has successfully been adapted to suit the unique needs of this population, including those who are dealing with suicidal thoughts. DBT has been found to be a good fit for eating disorder treatment for a number of reasons. First, its focus on emotional regulation and concrete behavioral change aligns closely with the longstanding priorities of eating disorder treatment. Second, DBT’s team-based approach provides a valuable support system for professionals treating eating disorders, while also offering multiple sources of emotional connection for the patient. What’s more, DBT’s emphasis on mindfulness skills can be readily applied to the mindful eating practices that are often key to eating disorder treatment.

To date, an increasing body of research has shown that modified versions of DBT are effective in treating eating disorders, and some studies also indicate that these same treatments are helpful for people who have both an eating disorder diagnosis and another serious mental health diagnosis, such as borderline personality disorder. In part because DBT is such an effective treatment for suicidal thoughts and self-harm more generally, it’s now considered a particularly strong treatment for these symptoms among people with eating disorders as well.

At Columbus Park, we observe that suicidal thoughts and self-harm are significant issues among the patients we see, all of whom come to us with eating disorders as well.   After thorough assessment and delivery of a targeted battery of diagnostic questionnaires, we’re able to establish if our DBT for ED model will be the right course. For these higher risk patients in particular, DBT gives us, as providers, an ideal structure to be able to keep patients well monitored and safe as they engage in the treatment process. We find that suicidality and self-harm most often decrease and eventually resolve as our patients move through the DBT protocol and gain more skills for coping effectively with their emotions and the challenges within their lives.